Gardasil, manufactured by Merck & Co., is a vaccine given to prevent… (JB REED, BLOOMBERG NEWS…)

August 06, 2013

A few of the common and recurrent questions that I hear during office visits with women recently diagnosed with a gynecologic cancer are the following: "Why did this happen to me?" "What did I do wrong?" "Is this one of those hereditary cancers that puts my children at risk?" "What can my daughter do to prevent her from acquiring this disease?"

Unfortunately, these remain difficult and sometimes painful questions to answer. Despite huge strides in cancer research, there still is a lot we do not know. Most cancers are the result of innumerable, subtle and unpredictable molecular and genetic changes. Therefore, the answer to more than 90 percent of my ovarian and endometrial cancer patients' questions is a plain and ultimately nonreassuring, "Sorry, but we just don't know."

But what if we did know?

For more than a century, we have been able to identify precancerous cells in the uterine cervix by a simple and noninvasive exam: the Pap test. The implementation of massive screening campaigns over the past 30 years has led to a dramatic decrease in cervical cancer mortality worldwide. Despite this, cervical cancer still ranks at the top of women's cancer death statistics in most countries.

Unlike other malignancies, we know a lot about cervical cancer. We know the cause of cervical cancer, we can recognize precursor lesions that can be treated and in the vast majority of cases, we can prevent its occurrence. Most cervical cancers are the result of screening failures — meaning lack of compliance with periodic examinations with Pap testing.

In the United States, we estimate that more than 12,000 women will be diagnosed with and 4,000 women will die of cancer of the cervix this year. In some cases the burden associated with a cancer diagnosis makes it difficult to answer the patients' questions as these conversations can potentially generate remorse and guilt for the patient.

Nonetheless, for more than 99 percent of the women diagnosed with cervical cancer this year I would have clear and straightforward answers.

I would say: "Your cervical cancer was caused by a high-risk genotype of the human papillomavirus — HPV. You did nothing wrong. Unfortunately almost 90 percent of the world's population has evidence of past exposure to HPV; this is not a rare and unlucky occurrence. Yes, your daughters are at risk of exposure to HPV and can develop precancerous conditions that may lead to cancer of the cervix, vulva, anus, larynx, throat and lungs (and the list keeps growing). By the way, your boys are also at risk for many of those HPV-associated cancers, too! Your children are not at especially high risk because of your history, but because of how widespread and contagious the HPV virus infection is. Therefore, cervical cancer and other HPV-related diseases can definitely affect them. In fact, a single exposure to the virus carries a 50 percent chance of becoming infected."

Another fact we know is that cervical cancer is definitely preventable. With a safe and widely available vaccine — approved by the Food and Drug Administration and recommended by the Centers for Disease Control and Prevention — we can prevent more than 70 percent of cervical cancers and probably many of the other cancers I mentioned.

A recent, highly publicized study confirmed what we already knew. Only about one in three girls and young women has received the vaccine since 2006 when it was approved by the FDA. Despite such poor usage, the rate of infections by vaccine-targeted HPV genotypes has dropped by almost 60 percent.

With the help of parents and caregivers, I know we can do way better for our young men and women. The HPV vaccines are safe and proven effective — and the vaccines are approved for young women and young men. Please help us prevent more of those 12,000 painful conversations by vaccinating your children against HPV. Your choice just may save their lives.

Israel Zighelboim is a gynecologic oncologist with St. Luke's University Health Network.